Protein-calorie malnutrition as a prognostic indicator of mortality among patients hospitalized with cirrhosis and portal hypertension

Background: We conducted a nationwide analysis of the prevalence of protein-calorie malnutrition (PCM) in patients with cirrhosis and portal hypertension (PHTN) and to determine its mortality and economic impact. Methods: We used the Nationwide Inpatient Sample (NIS) to identify admissions throughout the US with cirrhosis and PHTN between 1998 and 2005 using the International Classification of Diseases, 9th Revision diagnostic codes. Prevalence of PCM in this group of patients with cirrhosis was compared with that of general medical inpatients. The impact of PCM on in-hospital mortality was quantified using multiple logistic regression analysis. Results: There were 114 703 admissions with cirrhosis and PHTN in the NIS between 1998 and 2005. The prevalence of PCM was substantially higher among patients with cirrhosis and PHTN compared with general medical inpatients (6.1 vs. 1.9%, P < 0.0001), with an adjusted odds ratio of 1.55 (95% CI: 1.4-1.7). There was greater prevalence of ascites (64.6 vs. 47.8%, P < 0.0001) and hepatorenal syndrome (5.1 vs. 2.8%, P < 0.0001) among those with PCM and cirrhosis. In-hospital mortality was two-fold higher among patients with cirrhosis and PCM (14.1 vs. 7.5%, P < 0.0001), with an adjusted mortality of 1.76 (95% CI: 1.59-1.94). PCM was associated with greater length of stay (8.7 vs. 5.7 days, P < 0.0001) and hospital charges (US$ 36 818 vs. US$ 22 673; P < 0.0001) among patients with cirrhosis. Conclusions: PCM is more common among patients with cirrhosis and PHTN than the general medical population, and is associated with higher in-hospital mortality and resource utilization. PCM may be an indicator of greater disease severity and should be routinely assessed on admission.